[罂粟摘要]心房利钠肽预防心脏移植术后急性肾功能不全——一项随机安慰剂对照双盲试验

心房利钠肽预防心脏移植术后急性肾功能不全——一项随机安慰剂对照双盲试验

贵州医科大学 麻醉与心脏电生理课题组

翻译 :  马艳燕

编辑 :  严旭

审校 :  曹莹

背景：心脏移植术后的急性肾损伤（AKI）和肾功能不全是常见且严重的并发症。心房利钠肽 （ANP） 已被证明可提高肾小球滤过率 （GFR） 并发挥肾保护作用，用于预防或治疗心脏手术中的AKI。我们验证了这样的假设，即术中和术后给予ANP可以防止心脏移植术后早期肾功能下降。

方法：70名患者随机接受ANP(50ng/kg/min)(n=33)或安慰剂(n=37)，从麻醉诱导后开始，持续到心脏移植后4d或开始透析治疗。本研究的主要指标是在术后第4天测量的GFR（mGFR），通过肾滤过标志物的血浆清除率进行评估。此外，还评估了术后AKI和透析的发生率。

结果：安慰剂组和ANP组术后第4天的中位(IQR)mGFR分别为60.0 (57.0)和 50.1 (36.3)ml/min/1.72 m2(p=0.705）。在持续的ANP输注期间，安慰剂组和ANP组的透析率分别为21.6%和9.1%（p =0.197）。安慰剂组和ANP组的AKI发生率分别为76.5%和63.6%（p =0.616）。安慰剂组和ANP组AKI 1期的发生率分别为32.4%和21.2%（p =0.420），AKI第2期或3期的发生率分别为37.8%和42.4%（p =0.808）。

结论：该研究未能证明ANP输注可以减轻心脏移植术后肾功能不全或降低AKI的发生率。

原始文献来源 ：  

Tholén M, Kolsrud O, Dellgren G, Karason K, Lannemyr L, Ricksten SE. Atrial natriuretic peptide in the prevention of acute renal dysfunction after heart transplantation-a randomized placebo-controlled double-blind trial. Acta Anaesthesiol Scand. 2023 Mar 20. doi: 10.1111/aas.14241.

英文原文

Atrial natriuretic peptide in the prevention of acute renal dysfunction after heart transplantation—a randomized placebo-controlled double-blind trial

Background: Acute kidney injury (AKI) and renal dysfunction after heart transplantation are common and serious complications. Atrial natriuretic peptide (ANP) has been shown to increase glomerular filtration rate (GFR) and exert renoprotective effects when used for the prevention/treatment of AKI in cardiac surgery. We tested the hypothesis that intraoperative and postoperative administration of ANP could prevent a postoperative decrease in renal function early after heart transplantation.

Methods: Seventy patients were randomized to receive either ANP (50 ng/kg/min) (n = 33) or placebo (n = 37) starting after induction of anesthesia and continued for 4 days after heart transplantation or until treatment with dialysis was started. The primary end-point of the present study was measured GFR (mGFR) at day 4, assessed by plasma clearance of a renal filtration marker. Also, the incidence of postoperative AKI and dialysis were assessed.

Results: Median (IQR) mGFR at day 4 postoperatively was 60.0 (57.0) and 50.1 (36.3) ml/min/1.72 m2 for the placebo and ANP groups, respectively (p = .705). During ongoing ANP infusion, the need for dialysis was 21.6% and 9.1% for the placebo and ANP groups, respectively (p = .197). The incidences of AKI for the placebo and the ANP groups were 76.5% and 63.6%, respectively (p = .616). The incidences of AKI stage 1 were 32.4% and 21.2% for the placebo and ANP groups, respectively (p = .420) and for AKI stage 2 or 3, 37.8% and 42.4%, respectively (p = .808).

Conclusions: The study failed to detect that ANP infusion attenuates renal dysfunction or decreases the incidence of AKI after heart transplantation.

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